Endocrine Head & Neck Surgery

Stanford Head & Neck Center

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Gotier & Treatments

What is Gotier?

Goiter is an abnormally enlarged thyroid gland. Goiter is a common condition in parts of the world where there is iodine deficiency, but the increased use of iodized salt in many countries has virtually eradicated this type of goiter. Goiters found in the United States today are most often a result of the gradual and progressive growth and overlap of benign thyroid nodules. Goiter tends to occur randomly, but it can also be associated with some medications and/or with other thyroid conditions or family trends. If the goiter extends from the neck into the upper chest, it is called a substernal goiter.

Patients with goiter may notice a visible distortion of the neck, the sensation of a lump in the throat when swallowing and/or actual difficulty swallowing. They may also have difficulty breathing due to compression of the windpipe. Goiters can even contribute to, or be mistaken for, breathing disorders such as sleep apnea or asthma.

Diagnosis

It is important to assess the function of the thyroid gland in patients with goiter through comprehensive blood testing, since at times goiter can be associated with hyperthyroidism or Graves’ disease.  In addition to blood testing and an appropriate physical examination of the thyroid, voice box and neck, the thyroid surgeon evaluates the exact degree of enlargement of the thyroid and its impact on the neck and upper chest structures. This is accomplished through ultrasound evaluation and occasionally even by CT or MRI scanning of the neck and upper chest. If individual nodules within the goiter have suspicious characteristics, they are further evaluated as described for thyroid nodules.
Patients diagnosed with hyperthyroidism are first evaluated and treated by endocrinologists, specialists in treating medical thyroid issues. The endocrinologist may order additional testing for hyperthyroidism, which may include a nuclear medicine scan.  The endocrinologist will often prescribe medication to help control the hyperthyroidism, while helping determine the best long-term plan of action.

Treatment

There is no routine medical treatment that can reduce the size or growth of a goiter. Typically, thyroid goiters are comprised of multiple benign nodules that grow slowly over time. If these nodules are causing a visible lump in the neck, putting pressure on your trachea (windpipe) or esophagus, or expanding behind the collar bone, surgery may be indicated. This can involve removing half or all of the thyroid gland, depending on the size and location of the nodules as well as the results of your other diagnostic tests. Your surgeon will consider all of these factors carefully and discuss recommended options with you at your clinic visit.